4th year stuff - letters, aways, etc.

Yea for me I'm doing three away rotations back to back to back. It's going to be a long three months away from the family, but I hope I have the stamina for it. I don't have a home ortho program, and don't even start 4th year until Aug 3rd which kind of puts me behind the eight ball. I think any research is good, research in surgery is probably better than basic science, and research in ortho is better than that. A lot of people have matched without research obviously, but it seems now it's just more of an equalizing factor than really putting a person above the pack.

Good luck to all this year, I know I'm nervous as all get out with this process.

You're right about being concerned for stacking tough aways back to back. They do wear you down. However, doing a lot of ortho makes you pretty comfortable with the bread-and-butter stuff that med students should know. I did 3 orthos back to back and really rocked my last one because I had become very comfortable with the common questions about hips, distal radius and ankles.

As for research, I really dont think its right to rank ortho/surgical/basic science research. What really counts is that you can actively talk about your research with interest and indicate that performing basic science or clinical research in ortho is what you plan to do in your residency (usually by force) and for your career (again, maybe not true, but most programs are in academic centers with research-minded staff).

So dont be afraid to take consecutive aways and be proud of your research!

The research is fine, however, I would shoot for all ortho letters.

Don't waste your time doing a urology rotation to get a letter. A urology letter will not be useful to you. In my experience going through this application process last year I noticed that your letter writers weigh heavily into the interview invitation process. You'll get an interview from programs because someone on their selection committee is friends with one of your letter writers. The regional card comes into play here as well because if you get a letter from say Program X in Boston, you'll likely get an interview from Program Y in Boston because they are friends with the faculty member at their neighboring institution or see them at meetings regularly. Therefore do not waste your time getting a urology letter -- get all ortho letters. The urology research is still useful because research in another field is better than no research at all. I had a bunch of ophthalmology research and although it was talked about at maybe one interview it still showed that I was involved in scholarly activity.

For the guy who has no home ortho program, plan to do your away rotations early and try to get letters from each one.

My end of 3rd year/beginning of 4th year went like this: May SICU, June home ortho, July Step 2, Aug/Sep/Oct away ortho rotation X 3. This was probably overkill, but the SICU depending on what your home institution is like was actually very light and preparing for Step 2 was a breeze compared to Step 1. After the aways I did feel exhausted, but i definitely felt like I knew my stuff very well on those later rotations. And hey.. you're preparing for ortho residency and during residency you don't have a month off here and there to do an easy rotation. Just my thoughts.

So say you did a research summer/time in a non-ortho lab (probably a decent amount of applicants). I personally spent my year2/3 summer in a gensurg lab and would get a great letter from the attending I did research with. Should I even use this letter for my apps other than the few places that require a non-ortho letter?

Everyone has a different theory on this so feel free to disagree. Ortho people want to read ortho letters. A letter means more to the reader if it is someone they know or have at least heard of. The more "academic" the program, the more this holds true. For example, I did a rotation at a top tier academic program and the program director told me during my rotation that he wants to see letters from colleagues he knows well. He doesn't care for a glowing letter from someone that is unknown in the academic world. This was a shock and surprise to me because I had always been told that a glowing letter from a random attending that knows you very well is much much better than a so so letter from a big name guru.

That gen surg letter may only be useful if you are applying to community programs. Again, this is just my opinion. This might be a great question for the ask the attending section.

How tough is your typical away rotation? Hours/call schedule/responsibilities-wise? etc..

Any schools, other than Duke, that require step 2 CK completion in order to interview/rank you?

asmallchild,

Aways do depend on what kind of service you are on. Orthopaedic trauma is usually the heaviest. Call responsibilities can be determined already by the program or can be left up to the rotator. My experience is generally 1 in 3-5 call. Rounds are also program specific.

Student responsibilities are usually to see new consults in the ER, and help the staff with clinic/OR. Your routine could change each day depending on where people are needed.

Just go where you are told to go, and do a good job. There's no board exam at the end, so read for your own knowledge.

In follow up to step 2 CK question:

What are recent grads' thoughts on taking step to as late as, or later than December, assuming one's happy with their step 1 score. Do any schools look down on this?

Thanks in advance.

Came across this on another message board site from Dr. Levine in response to my previous question - hope it helps anyone that's interested. Would appreciate other input if there is any. From Dr. Levine:

I am unaware of any program making interview decisions based on step 2 scores. If you nailed step 1 then taking step 2 might pose problems if for some reason you do particularly poorly. On the other hand, if you did poorly (or relatively poorly) on step 1 and want to show the programs that you are in fact a good standardized test taker (step 2 MAY correlate better with orthopaedic in-traning scores and board passing rates) - then you really have nothing to lose. If a program didn't like your step 1 score they may not pay attention to your step 2 score no matter how good it is. On the other hand, if you do phenomenally well on step 2 perhaps it will get the attention of someone and you may get some interviews that you otherwise wouldn't have.

good luck and hope this answered your question --

wnl

I can only give some anecdotal experience on the "Should I/Shouldn't I take Step II" question.

I personally didn't do well on Step 1, as I had my ACL reconstructed a month before I took it. However, I decided to take Step 2 early and killed it, and included it on my ERAS. I know that I didn't get interviews to some of the top tier programs because of the Step 1. But more than one interviewer commented on the difference between Steps 1 and 2 and it gave me an opportunity to explain why my step 1 score was sub-par.

I think Dr. Levine's answer merits some consideration, especially in light of your application as a whole.

Does anyone have any advice on things to study before going into the sub-I? A resident I talked to said to definitely get Netter's Ortho Atlas and Koval's Handbook on Fractures, and to know some high yield things like Salter-Harris, Lauge-Hansen, radial fractures and some commonly used blocks. Since a lot of us have almost no exposure to Ortho before the sub-I, is there anything else that's worth studying up on to get a good foundation and really hit the ground running?

The general consensus here is that you are only responsible for anatomy. The rest is gravy. I got the book Gowned and Gloved a little while ago. Went in on a total hip this morning after reading about it last night and was able to follow what the surgeon was doing step by step. I like this book. There is also another forum for textbooks and such. You might check that.

Three Ortho aways back to back aren't too hard provided you don't do three trauma rotations or something like trauma, spine, joints back to back... Give yourself a break and do sports or hand or the like during one or two of them. You will still work hard but the hours will be better and the residents you work with will be in a better mood.

1) Is it possible to hide Step 2 CK scores? ie opt out of sending them to schools.

2) If so, can you later reveal them, e.g. if you do well or better than on Step 1?

So for a single sub-I, would a student typically spend the entire month at that institution on one service, e.g. sports, spine, etc.? And then do another sub-I at another institution, doing, e.g., hand for the entire month?

Thanks.

It's institution specific.... I know WashU, Rush, and some others actually have you see a few services, while others have you on one service the entire month. Just break it up or you'll get bored and maybe know a little too much for your own good by the time your third away rolls around.

Stellar; thanks so much. This has been a huge help to me as newbie.

If it were possible logistically and financially, would it be advantageous to try to do more than three away rotations? How about four? It seems like this would give us, as the students, the chance to: 1) learn from/about at least one more program and 2) increase our chances by potentially having the opportunity for one more interview, if that institution grants interviews to rotators.

Thank you for your opinions.